<p> TRAVEL REIMBURSEMENT FORM</p><p>TRAVEL REIMBURSEMENT OF UP TO $500 ONLY. REIMBURSEMENT WILL NOT EXCEED $500. (Receipts Required: Total Miles Driven OR original receipts, or copy of etickets)</p><p>Name: </p><p>Mail my reimbursement check to: (street address)</p><p>(city, state, and zip code)</p><p>Arrival: I am requesting reimbursement for travel from to Chapel Hill. (city & state)</p><p>Departure: I am requesting reimbursement for travel from Chapel Hill to</p><p>(city & state)</p><p>Mode of Transportation: Those arriving/departing via plane, bus, or train MUST submit your receipt or NO reimbursement will be made.</p><p>Plane (airline ticket or eticket attached) Bus (bus ticket attached) Train (train ticket attached) Car ( number of miles roundtrip- attach mapquest mileage) TAXI Receipt(s)- if you travel via taxi from airport to Chapel Hill, submit a copy with this form. If you travel via taxi from Chapel Hill to the airport upon your departure, fax your receipt (919-843-2554) once you have reached your destination.</p><p>Return completed form & backup documentation to Darla Wohlfarth before departure: Kenan Labs, Suite A207 UNC Campus</p><p>For Office Use Only Total Amount Requested (up to $500): $ Total Amount Reimbursed: K # </p>